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General NPI Number Information
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NPI Number | 1821324997
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Entity Type | Organization
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Legal Business Name | CHARLES L. FOSTER JR. DDS INC.
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Dates
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Enumeration Date | 10/26/2009
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Last Update Date | 10/26/2009
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Provider Practice Location Address
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Address Line | 3800 W EL SEGUNDO BLVD SUITE 203
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City | HAWTHORNE
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State | CA
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Zip | 90250-4677
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Country | US
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Telephone | 310-679-0687
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Fax |
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Provider Business Mailing Address
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Address Line | 3800 W EL SEGUNDO BLVD SUITE 203
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City | HAWTHORNE
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State | CA
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Zip | 90250-4677
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Country | US
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Telephone | 310-679-0687
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. CHARLES L FOSTER JR.
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Credential | DDS
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Telephone | 248-635-6449
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 53412
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License Number State | CA
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